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High-Risk Security Vulnerabilities Identified During Reviews of Information System General Controls at Three California Managed-Care Organizations Raise Concerns About the Integrity of Systems Used To Process Medicaid Claims

We summarized the high-risk security vulnerabilities that we identified as audit findings in our previous reviews of information system general controls at three California Medi Cal managed-care organizations (MCOs). We identified 74 high-risk security vulnerabilities in the information system general controls at the 3 Medi-Cal MCOs we reviewed. We grouped these 74 vulnerabilities into 14 security control areas within 3 information system general control categories: access controls, configuration management, and security management. In 6 of the 14 security control areas, all 3 MCOs had vulnerabilities, which accounted for 53 of the 74 vulnerabilities. Accordingly, we determined that most of the 74 vulnerabilities were significant and pervasive.

In six of the security control areas, we noted similar vulnerabilities in all three MCOs' information systems, which indicated that the vulnerabilities identified were systemic and pervasive across the MCOs. We performed the same audit steps to assess each MCO's general controls; however, because of minor differences in the types of information systems at each MCO, we cannot conclude that all Medi-Cal managed-care information system security environments have similar vulnerabilities.

Our consolidated findings from the individual reports show significant vulnerabilities in the three MCOs' information systems and raise concerns about the integrity of the systems used to process Medicaid managed-care claims. California's Department of Health Care Services (State agency) informed us, in comments on the individual reports on the MCOs' information system general controls, that it was addressing these vulnerabilities. The fact that some of the same vulnerabilities were identified at all three MCOs suggests that other California Medi-Cal managed-care information systems may be similarly vulnerable. This report is intended to provide information to assist the State agency and CMS in strengthening MCOs' system security.

Filed under: Centers for Medicare and Medicaid Services